What messages is society giving to abusers...

At the end of an action-packed day, the sound of about 200 people’s thunderous applause said everything! The light and spacious Carrs Lane venue was packed, and I could sense the bubbly energy of anticipation even as we queued to book in.

Jo Watson was happy to be on her home ground! Her spirited overview of how the biomedical model of distress disregards experience but informs everything to do with distress, so that “the ‘illness’ becomes the story” – accompanied by her now widely heard tale of her encounter with Ruby Wax! – set the tone for the day.

Jo outlined for us the pervasiveness and influence on society of psychiatric diagnosis. She demonstrated the links to the biomedical approach in organisations like the charity Mind, which lists mental ‘disorders’ and treatments, and the fact that even the online Counselling Directory itself lists 10+ types of ‘disorder’ which therapists can claim to address.

We were invited to go online and put a list of ‘symptoms’ into ‘Doctor Google’ to receive a ‘diagnosis’, a label of mental ‘ill health’.

As Jo so aptly put it: “What messages is society giving to abusers when victims are given disorders as the explanation for distress?”

It’s only words!

Clare Shaw’s impassioned poetry reading picked up Jo’s theme of language and stories, that language is how we connect with each other, how we understand ourselves – and about how dangerous it is to say to a writer: ‘It’s only words!’

Clare’s ‘Poem about Dee Dee’, ‘Poem for a Bus Shelter’, ‘I Do Not Believe in Silence’, and the new poem she wrote last week all took us on a roller coaster ride through lived experience of abuse, emotional distress silenced, sexual identity, and the personality disorder diagnosis which “confirmed everything bad I thought about myself”.

So Clare’s extensive self-injury over two decades became her loud voice: “I cut myself, banged my head, took overdoses, listened to Leonard Cohen ….. What more could I have done?”

In this cry for speech and meaning, Clare noted that, in her experience, psychiatric patients, behind locked doors, are the most silent of all.

There is no definition of a mental disorder

Lucy Johnstone was on top form, but with a bad case of ‘Too many words on my slides disorder’ – which would make the number of disorders in the DSM5 (Diagnostic and Statistical Manual of Mental Disorders) add up to about 301!

What followed was an erudite and detailed tour de force of the problems with psychiatric diagnosis from the theory and lived experience perspective, and the need to provide CHOICE in the approach to addressing people’s distress: “It’s important to have your own view of what feels right to you – but you need to have the information….. Acceptance of a diagnosis should be on the basis of informed choice, and not a view imposed by a professional.”

Lucy was, as usual, being fair, but it was difficult to accept the biomedical approach fully when the chair of the DSM4 committee, Dr. Allen Frances, can be quoted as saying: ‘There is no definition of a mental disorder. I mean, you just can’t define it. It’s bullshit.’

Lucy spoke even more strongly than I’ve heard previously about her challenge to psychiatric diagnosis as the main response to emotional distress. Her book ‘A Straight Talking Introduction to Psychiatric Diagnosis’ (PCCS Books, 2014) summarises the arguments about diagnosis in an accessible way and describes some of the alternatives to diagnosis. She also referred to ‘Searching for a Rose Garden’ edited by Jasna Russo & Angela Sweeney (2016, PCCS Books), about survivor-led initiatives and experiences. Both books flew off Pete Sanders’ PCCS Books book stall at coffee time! See: https://www.pccs-books.co.uk/

Today, in particular, Lucy emphasised the damaging effect of the export of diagnosis to non-Western cultures, since it is based on white, Western standards, and distress is best understood within the cultural context in which it occurs.

Within a trauma-informed perspective, Lucy showed how psychological formulation – working with a person to support them to tell their own story – is a credible, evidence-based alternative to psychiatric diagnosis. Otherwise, the story we can learn to tell about ourselves is just that there’s something ‘wrong’ with us, that we are ‘ill’.

Lucy took us through an example of formulation, how events from a person’s life experience can be constructed into a negotiated ongoing formulation, or story, which summarises issues and lists the person’s strengths and aims, to form the basis of agreed actions, and she asked the audience how it felt. Responses included: ‘Very positive’; ‘Gives hope’; ‘Being heard’; ‘Provides a context so experiences are understandable’; ‘Recognises that her behaviour is normal’; ‘Gives more equal power’.

Somehow, within the context of lived experience, behaviours could be explained and understood, and the diagnosis of a ‘disorder’ seemed unnecessary.

There was a lot more to Lucy’s presentation, far too much for me to do justice to here. I can only advise you to do your best to come and hear her speak.

The Infallible Victim

Jessica Eaton: After the break, speaking about victim-blaming, Jessica revealed some quite startling statistics, that 38% of men and 34% of women would put partial or total blame on a woman if she is raped. Services too were not free from bias: if the victim doesn’t fit the stereotype, they are less likely to be believed.

Jessica took us through ‘The Infallible Victim’, a collection of misperceptions and stereotypes which showed how, as a victim, you can’t win. For instance, with regard to alcohol consumption, how come a female victim is more responsible (she shouldn’t have had that extra drink) whereas a male perpetrator is less (of course he couldn’t control himself, he’d been drinking)?

Jessica’s research and her voluble support for victims, including challenging their distress being diagnosed as illness, have led her to design a series of impressive posters which challenge misconceptions. Take a look at the Resources section of her website, www.victimfocus.org.uk and watch out for her forthcoming book in September ‘The Little Orange Book’ which tells of her own story

Sometimes language runs out

Chris Coombs’s acerbic and insightful blog, is gaining growing recognition, and he gave us some extracts from it. For Chris, “sometimes language runs out” – though he spoke out cogently and passionately about depression, suicide, and how, initially, he found that, through his diagnosis, “there’s real liberation in that new identity,” as it gave his feelings a name, so they could be talked about, and took away the need to apportion blame.

From there, Chris’s life-changing experience came when he looked back to see what had got him the depression diagnosis if it wasn’t pathology ….. and so he became one of the “reformed mentals”, to use his own words, recognising that at least the last decade has developed to allow depression to be a topic of conversation – though people still shy away from it, as his blog, ‘Me Myself and Disability’ illustrates.

So what are his feelings now? Chris’s message is uncompromising: “Emotional complexity is not pathology….. Labels are not useful. Far from being liberating, they are mere straitjackets.”

As for the so-called social model of disability? Don’t even ask!

Holistic Empowerment Recovery (HER) Model

Akima Thomas’s powerful presentation on the Holistic Empowerment Recovery (HER) Model illustrates a process which has been ongoing for 30 years now and doesn’t pathologise women’s experience. Akima described a lifetime spiral of gendered violence, global and endemic to all cultures, and demonstrated how women can and do resist and fight back against these situations in many small and effective ways.

Akima was strong on the practice of trauma-informed care – assessment, safety, stabilisation through bringing back harmony and balance, followed by testimony: telling your story. She reminded us that violence can also be state-based, and that, despite the current debate about resilience, survivors “don’t have any choice other than to ‘get on with it!’”, with post-traumatic growth demonstrating women’s strengths, tenacity, and ability to survive.

Akima illustrated this through the story of a young Nigerian woman who, following her parents’ deaths, was brought to the UK, forced to work in a brothel, then sold to an older man as a slave, before she managed to escape. Through the support of the Women and Girls Network, over time, she is now training to become a medical doctor.

To achieve positive results, Akima stressed the need to “bring back the love”: “Who said that therapeutic spaces had to be cold?” They need to be places where positive relationships can happen.

One key point Akima made was about the importance of cultural competency, and how we would all benefit from reviewing our own practice and from thinking about our relationship to oppression.

Time for lunch and a big networking opportunity! My brain was reeling and my legs were stiff from all the sitting down but it was worth it! I checked out the information stalls, the PCCS bookstall with Pete Sanders himself, and Tom Bailey’s new set of on-the-spot cartoons!

Power Threat Meaning (PTM) Framework

Lucy Johnstone: Lucy focussed on the Power Threat Meaning (PTM) Framework, which is creative, optional, weighty, not a replacement for other approaches, and fits in with other initiatives. Mainly, the framework “sees people in their social and relational environments.” We were advised to look at the two-page summary – then get a copy of the Overview document free from the British Psychological Society (BPS) and read Chapter 8, about the possible alternatives to psychiatric diagnosis. Email: membernetworkservices@bps.org.uk for your free copy – you don’t have to be a member!

We heard about how the PTM Framework came to be, through a chance conversation between a group of colleagues in a Manchester hotel about what alternatives to psychiatric diagnosis might look like, and how the group grew over five years to include a variety of professionals, survivors, and a consultation group.

The theme of this presentation was Power, and how putting it into the PTM equation relates to how society is constructed. In particular, ideological power, the power of beliefs, was seen as dangerous in that “we’re not aware of the assumptions we’re making”.

Lucy explored the varied abuses of power, which affect both women and men, and showed how individual meanings are never just chosen but are influenced by societal and cultural context. She demonstrated how the PTM Framework helps to identify the many ways in which people cope with overwhelming feelings (their threat responses), and how the positive side of power lies in helping a person to identify their strengths and resources.

The PTM approach doesn’t pathologise; the patterns of distress identified in the framework are organised by Meaning, not Biology, and different expressions of distress can be looked at openly. In this way, the framework allows for cross-cultural application, as it recognises that “Western norms and standards are not accepted as general across different societies and cultures”. It also acknowledges the threat of social discourses, telling us what we’re ‘supposed’ to feel.

The responses to the key questions of the framework:

What has happened to you?

How did it affect you?

What sense did you make of it?, and

What did you have to do to survive?

with the addition of:

What are your strengths? and

What is your story?

can then be integrated into a formulation which provides the basis for negotiated therapeutic interventions.

Finally: from theory into practice: Lucy invited us to experience the PTM Framework, by going to Appendix 1 and and trying out the Guided Discussion there for ourselves.

This, for me, was the message of the day

Jacqui Dillon is a prime example of how someone with “only 3 O-levels” and a lot of life experience was recently awarded a well deserved honorary doctorate by the University of East London. She spoke to us warmly, irreverently, and with humour, about what it means to be an Expert by Experience, and how that impacts on every aspect of life, confirming that both distress and madness are both personal and political.

Jacqui told us some of her story, about being born into an abusive family, who manipulated children’s attachment needs for their own ends. Her journey through her childhood, via psychiatry, to the realisation that her distress was not the result of illness but of her early experiences, is well documented.

Today she described the comforting nature of some of her voices, which she began to hear at the age of 3, and which “helped me to survive with my humanity intact, and helped me to be a good mother”.

At the age of 7, cutting herself was a “sophisticated survival mechanism”, giving release to the awful feelings that she had.

To Jacqui, pathologising her early life experiences was seen as “adding insult to injury”: “‘Abnormal psychology’? That’s me! WTF!”

Jacqui attributes her survival to a combination of mind plus body plus spirit. She identifies with people who are oppressed, and with the search for justice.

Her turning point was the birth of her first child, a daughter. The negative voices of the abusers were still strong, and Jacqui’s experiences with psychiatry didn’t help: she had to “lie, comply, and resist” to get out of that one! “I went in there wanting to kill myself and left wanting to kill other people!” got a lot of laughter and appreciative applause!

Here again, Judith Herman’s book ‘Trauma and Recovery’ was the ‘book of change’ for Jacqui: “It literally blew my mind!” She finally discovered her survivor mission and her social action, to “speak the unspeakable”.

Jacqui told us about the Beck Road Alliance, the organisation she created to support and obtain justice for the children and young people, now adults, who were caught up in the paedophile groups that her parents and other adults created. As she says: “Silence won’t protect us; only the truth will set us free”.

This is one of the many ways in which “survivors have so much to teach society”. Today demonstrated so clearly that this is something we can’t deny.

Come out from behind your mask

Workshop sessions: Two workshops followed. Despite wanting to be in two places at the same time I had to make a choice and so attended the RSVP one. (See Akima Thomas’s summary of the other workshop below!)

Lisa Thompson, from RSVP, the Rape & Sexual Violence Project in Birmingham, our hosts for the day, ran a workshop on: Distorted Beliefs and how they are used to blame and label.

Lisa invited us to “Come out from behind your mask and be who you are!” Judith Herman’s book ‘Trauma and Recovery’ featured large, and Lisa explained how trauma detaches people and how silence and silencing are used to deepen or obscure trauma. Once again, we were reminded how systems and institutions do this too, by questioning credibility and raising issues about drink, drugs and previous sexual experience.

Lisa quoted Nina Burrowes, the ‘cartooning psychologist’ whose illustrated books on trauma recovery are well worth checking out: “It suits society that survivors of abuse blame themselves.” So victims are Velcro-coated and perpetrators are Teflon-coated, and society teaches ‘Don’t get raped’, not ‘Don’t rape!’”, putting the onus on women to keep safe, which is difficult when ‘stranger danger’ obscures the fact that 80-90% of perpetrators are known to the victim.

Lisa was strong on empathy, its importance and its difference from sympathy: Empathy as ‘being with’, not ‘talking to’; empathy as a vulnerable choice; empathy as the connection that makes us human.

We were invited to consider and create a world which is more connected …..

The RSVP information table displayed some badges with bright yellow smiley-faces, but with one eye shedding a single grey tear. These represented the #OnlyUs movement: that there’s no ‘us’ and ‘them’, there’s ‘only us’.

This workshop with Eleanor Hope and Shazia Ali Provided a framework to understand mental health from an intersectional framework to explore the lived experiences of marginalised communities within the mental health system.

Eleanor began with startling statistics illustrating how the African Caribbean community are disproportionately represented in the mental health system, are more likely to be detained under MHAct and the least likely to be offered talking therapies.

Why?

Eleanor provided a historical perspective exploring links with slavery and the use of mental health diagnosis such as Draptomaina (to describe why slaves ran away from captivity) were used to support, legitimise and condone slavery. The presentation went onto to describe current initiatives to tackle mental health, which continue to be ineffective in preventing the same marginalised groups from being over represented in institutions such as prison and mental health system.

Shazia’s presentation focused on BAMER women and the likely diagnosis of Borderline Personality, which in effect is meaningless and again used as a strategy to oppress and marginalise communities. Concluding discussions focused on what could be done with suggestions for; more training, challenging current diagnosis and for the white community to become more activated in challenging racism.

I’m With Her

Jo Watson: Jacqui Dillon is always a hard act to follow, but Jo did just that. To end the day, Jo spoke her poem ‘I’m With Her’, an intergenerational moving message of empathy and support, based on Eleanor Longden’s and Jacqui Dillon’s advice to psychiatry: Don’t ask “What’s wrong with you?”, ask “What happened to you?”’ I hope Jo will put her poem on the website for more people to appreciate.

Finally, amidst prolonged applause, there were a lot of thank you’s, including for Nollaig McSweeney, who tirelessly MC’ed the whole event from start to finish.

Right now, it looks like the AD4E team is having the summer off! The next events will be held in London on September 6th Edinburgh on September 28th and Leeds on November 9th, so there’s only really one final question to ask:

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About AD4E

This one day event is for everyone who is interested in the current debates around mental health. It is a chance to discuss the critical questions of the day around the biomedical model in mental health. [more]